Pharmacy Practice Model Initiative Research Articles

The Journey to Advanced Clinical Pharmacy Practice: Global Collaboration Will Accelerate the Pace

The Journey to Advanced Clinical Pharmacy Practice: Global Collaboration Will Accelerate the Pace

Current practices in the delivery of pharmacogenomics: Impact of the recommendations of the Pharmacy Practice Model Summit.

This report examines and evaluates pharmacogenomics as an emerging science as it relates to the Practice Advancement Initiative and its predecessor the Pharmacy Practice Model Initiative's consensus statements for optimal pharmacy practice models. Pharmacogenomics is one of many emerging sciences to impact medication management and delivery of patient care. Increasingly, biomarkers are included in drug labeling and can assist pharmacists with personalizing medicine to optimize patient therapies and avoid adverse effects. The 2011 ASHP Pharmacy Practice Model Summit generated a list of 147 consensus statements for optimal pharmacy practice. Of these, 1 statement explicitly describes adjustment of drug regimens based on genetic factors as an essential activity of pharmacist-provided drug regimens, and 9 other statements provide additional support for incorporation of this emerging science into all aspects of patient care provided by pharmacists. We describe 4 institutions that have made significant inroads to implementing pharmacogenomics, to provide a framework and serve as resources for other institutions initiating their own pharmacogenomics implementation journeys. Through prioritized efforts of the pharmacy profession and health care institutions, pharmacogenomics will be disseminated and implemented, and the goal of the Pharmacy Practice Model Initiative's consensus statements of improving health care using patients' genetic characteristics will be realized.

Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice: An Alternative Viewpoint.

The American Society of Health-System Pharmacists’ Pharmacy Practice Model Initiative (PPMI) aims to develop and disseminate pharmacy practice models that optimize the use of pharmacists as direct care providers.1 In their commentary, Jacobi and colleagues highlight opportunities and challenges presented through the PPMI, and draw attention to potential negative consequences for clinical pharmacy specialists.2 We present the transplant specialist perspective. This article is protected by copyright. All rights reserved.

Utilization of Pharmacy Technicians to Increase the Accuracy of Patient Medication Histories Obtained in the Emergency Department.

The purpose of this study is to determine the accuracy of a pharmacy technician-collected medication history pilot program in the emergency department. This was completed by reviewing all elements of the technician activity by direct observation and by verifying the technician-collected medication list through a second phone call by a pharmacist to the outpatient pharmacy. This was a retrospective, single-center study conducted from March to April 2015. Four certified pharmacy technicians were trained by a postgraduate year 1 (PGY1) pharmacy practice resident on how to collect, verify, and accurately enter medication histories into the electronic medical record. Accuracy of pharmacy technician-collected medication histories was verified by a pharmacist through observation of their patient interviews, review of technician-completed medication history forms, and by contacting the patient's outpatient pharmacy. The pharmacy technician-completed medication histories resulted in an absolute risk reduction of errors of 50% and a relative risk reduction of errors of 77% (p < .001) in comparison to medication histories collected by non-pharmacy personnel. With high accuracy rates, pharmacy technicians proved to be a valuable asset to the medication history process and can enhance patient safety during care transitions. The results of this study further support the Pharmacy Practice Model Initiative vision to advance the pharmacy technician role to improve the process of medication history taking and reconciliation within the health care system.

Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.

Use of an electronic clinical scoring system to prioritize patients' medication-monitoring needs.

The Pharmacy Practice Model Initiative (PPMI) supports the right of all patients to receive care from a pharmacist. Clinical pharmacy resources in health systems are expensive and need to be aligned with best practices. The ASHP national survey of pharmacy practice in hospital settings measures

Putting the Strategy into Action.

J C P H – Vol. 68, no 4 – juillet–aout 2015 360 Board. I now look forward to joining the CSHP Executive Committee for my 3-year term as Vision Liaison, starting as President Elect for the coming year. Throughout my career, I have witnessed the growth of our profession and the impact of this change on patients’ health outcomes. Measures such as those published in the Hospital Pharmacy in Canada Report (www.lillyhospitalsurvey.ca/hpc2/content/rep_ 2015_toc.asp) and those included in the CSHP 2015 initiative (www.cshp.ca/cshp2015/index_e.asp) and the American Society of Health-System Pharmacists’ Pharmacy Practice Model Initiative (www.ashp.org/ppmi) help in monitoring progress toward objectives, comparing performance with benchmarks, assessing real value delivered to “customers”, and identifying improvement opportunities. Performance measures are crucial elements in driving change, as we can’t manage what we can’t measure! The key to successful strategy implementation will be to select the measures that best capture desired performance and then to review progress on these measures regularly and report developments to our members, supporters and stakeholders. The CSHP Strategic Plan 2015–2018 is our opportunity to contribute to the achievement of our vision and to put ideas for improvement into action. It is our opportunity to shape our Society for years to come!

Maximizing your potential to promote the Pharmacy Practice Model Initiative as a student.

The practice of pharmacy is evolving rapidly. The engagement of student pharmacists is vital in achieving professional advancements. The Pharmacy Practice Model Initiative (PPMI) is a valuable opportunity for pharmacy students to shape their careers and support the expansion of pharmacists’ role

Pharmacy Practice Model Initiative task force report: Improving participation in a survey on hospital pharmacy practices in Texas.

Results of an initiative to increase participation in a survey on hospital pharmacy practices are reported. In an initiative led by pharmacy residents at the University of Houston College of Pharmacy, a task force was created to boost the rate of response to the Hospital-Assessment Survey (HSA), an online benchmarking tool developed as part of the ASHP-sponsored Pharmacy Practice Model Initiative (PPMI). Under the guidance of leaders from ASHP's Texas affiliate and state health-system pharmacy leaders, an 11-member team of residents targeted Texas hospitals that had not responded to the HSA as of December 2013 and used phone and e-mail methods to encourage survey participation. Data obtained from newly responding institutions were aggregated with previously collected data on Texas facilities and compared with national data. During the 11-week initiative, 66 new HSA responses were received from Texas hospitals, raising the total number of respondents to 89 and boosting the overall participation rate from 4.3% to 16.7% (p <0.001). Analysis of the survey data indicated broad similarities among small and large Texas hospitals with regard to six optimal practice characteristics. Pharmacy practice models and characteristics in Texas overall were largely consistent with national statistics. The involvement of the PPMI task force was associated with a substantial increase in the survey response rate. The survey results indicated that, with a few exceptions, practice models and the use of optimal practices were similar at Texas hospitals of various sizes and between Texas hospitals overall and sampled hospitals nationwide.

ASHP national survey on informatics: assessment of the adoption and use of pharmacy informatics in U.S. hospitals-2013.

Results of the 2013 ASHP national survey on informatics are presented. Pharmacy directors from all types and sizes of U.S. hospitals were included in the sample of 4893 individuals invited to participate in an online survey. The survey contained over 600 data elements that addressed the adoption and use of a variety of pharmacy informatics and technology. Data were analyzed by hospital type and size, accounting for sampling procedures and differences in response rate. Of the 4893 surveys distributed, 465 usable surveys were returned, yielding a response rate of 9.5%. Nearly 33% of hospitals reported having a complete electronic health record (EHR) (i.e., no paper charts). Adoption rates for computerized prescriber order entry, clinical decision support, electronic prescribing, and bar-code-assisted medication administration indicated that these technologies are clear priorities. Nearly half of respondents indicated using solely paper-based medication reconciliation processes, while almost as many reported using processes that combined electronic and paper methods. Overall, automated dispensing cabinets were more common in U.S. hospitals than were carousels and dispensing robots. The adoption of patient portals and personal health records is becoming common. Technologies identified as enablers of the Pharmacy Practice Model Initiative (PPMI) were found in at least 25% of hospitals. The average total number of pharmacy information technology full-time equivalents was 3.12. This survey found widespread use of pharmacy informatics and technology across the entire medication-use process. Considerable progress was demonstrated in meeting meaningful-use measures for EHRs and meeting the recommendations of the ASHP PPMI.

Issues facing pharmacy leaders in 2015: suggestions for pharmacy strategic planning.

Issues facing pharmacy leaders in 2015 include practice model growth and the role of pharmacy students, clinical privileging of health-system pharmacists and provider status, medication error prevention, and specialty pharmacy services. The goal of this article is to provide practical approaches to 4 issues facing pharmacy leaders in 2015 to help them focus their department's goals. This article will address (1) advances in the pharmacy practice model initiative and the role of pharmacy students, (2) the current thinking of pharmacists being granted clinical privileges in health systems, (3) updates on preventing harmful medication errors, and (4) the growth of specialty pharmacy services. The sample template of a strategic plan may be used by a pharmacy department in 2015 in an effort to continue developing patient-centered pharmacy services.

Moving the Pharmacy Practice Model Initiative forward within a state affiliate.

Efforts to advance the ASHP Pharmacy Practice Model Initiative (PPMI) in the Michigan Society of Health-System Pharmacists (MSHP) are described. After the Pharmacy Practice Model Summit in November 2010, the board of directors of MSHP began to strategize ways to help health-system pharmacists in Michigan achieve the vision and concepts envisioned by the PPMI. The ultimate goal was to develop a process for acting on recommendations developed by the PPMI to advance the practice of health-system pharmacy in Michigan. A task force was formed and reviewed the 147 national recommendations from the ASHP Pharmacy Practice Model Summit and grouped them into related areas of focus. Six focus areas were identified: acute care, ambulatory care, education and training, organizational affairs and leadership, pharmacy technicians, and technology and information systems. A PPMI Michigan conference was arranged in which focus groups would assess these six areas. Each focus group was limited to six or seven participants, with a member of the task force serving as the facilitator for the group. Individual focus groups then formulated recommendations MSHP could develop into actionable strategies to address the key issues identified during the morning session. A total of 56 recommendations were submitted by the focus groups for consideration by all conference participants. Over 80% of the recommendations were deemed to be high impact/high feasibility. A process for acting on recommendations of the ASHP PPMI to advance the practice of health-system pharmacy within the state of Michigan was developed.

Implementation of the Pharmacy Practice Model Initiative within comprehensive cancer centers.

The progress made by cancer centers across the United States adopting the goals and measures of the Pharmacy Practice Model Initiative (PPMI) was studied. In collaboration with ASHP, the official PPMI hospital self-assessment (HSA) questionnaire and a 10-item supplemental survey specific to oncology pharmacy services were disseminated via e-mail to all 41 National Cancer Institute designated comprehensive cancer centers in the United States. The HSA results of 26 (63%) of the 41 institutions surveyed were included in the analysis. Of the 26 participating institutions, 15 (58%) also completed the supplemental survey. Advanced pharmacist roles are highly prevalent among comprehensive cancer centers, with all institutions giving pharmacists discharge counseling responsibilities and deploying pharmacists to patient care units. Twenty-five institutions (96%) provide some level of pharmacist-driven drug therapy management services in at least some areas or situations and most often in the inpatient setting. Implementation of automation and technology in the areas of dispensing and order entry has occurred in over 80% of institutions. Advancement of pharmacy technician roles has received the least attention, with only 13 centers (50%) giving technicians sole responsibility for traditional dispensing functions, and 11 (42%) allowing technicians three or more advanced responsibilities. Only 12 institutions (46%) have established mechanisms to hold their pharmacists accountable for medication-related outcomes. Based on the survey results, suggested areas of improvement include the provision of drug therapy management in the outpatient setting, advancement in technician roles, utilization of automation and technology particularly at the point of administration, and implementation of mechanisms to hold pharmacists accountable for medication-related outcomes of their patients.

Missing doses: a system at fault.

The American Society of Health-System Pharmacists (ASHP) Pharmacy Practice Model Initiative (PPMI) encourages the pharmacy profession to maximize the use of pharmacy technicians, advance the application of information technology in the medication use process, and optimize pharmacy practice models.1 Although the pharmacy profession has made significant progress over the past 5 decades, it is almost impossible to achieve these high clinical standards without ensuring accurate and timely delivery of medications. Hospital pharmacy missing doses have been greatly reduced over the past 15 years due to automated dispensing machines (ADMs), lean workflow, improved delivery techniques, and healthier nurse- pharmacy communication; however, issues related to efficiency, financial wastes, and safety issues remain alarming.2–6 Missing doses are defined as patient-specific orders a nurse is unable to locate at or near the time of administration. These missing orders may result from improper delivery, nonstandard administration times, diversion, insufficient or incorrect medications dispensed by the pharmacy, incorrect administration, or lack of storage and handling knowledge.7,8

Pharmacy Practice Model Initiative: Case Studies in Health-System Pharmacy

In 2008, the American Society of Health-System Pharmacists introduced the Pharmacy Practice Model Initiative (PPMI). The goal of this model is to promote pharmacy leaders, better manage resources, and increase focus on patient-centered and team-based care. Few studies have assessed the model’s implementation. PubMed and CINAHL were searched using keywords “pharmacy practice model,” “organizational,” and the MeSH term, “organizational,” from 2008 to 2013. Of the forty-nine findings (articles and summit highlights), two case studies met the inclusion criteria. The first case study involved the University of Minnesota Medical Center, a multi-campus academic medical center. This facility used technology such as pagers for decentralized technicians, computerized provider order entry, and wireless computers on wheels. The implementation teams worked on clinical and distributive functions allowing for consistency in care and improved employee satisfaction. The second case study involved Providence Health & Services, a multihospital system in Washington State and Montana. These facilities used technology such as automated dispensing cabinets, order-image scanners, and automated telephone trees to route calls. The outcome was a positive economic impact with a return on investment of $709,321. An important finding was the lack of research assessing the implementation of the PPMI. Based on positive findings, it is evident that further research is warranted.

The need for PGY2-trained clinical pharmacy specialists.

The American College of Clinical Pharmacy and other stakeholder organizations seek to advance clinical pharmacist practitioners, educators, and researchers. Unfortunately, there remains an inadequate supply of residency-trained clinical specialists to meet the needs of our health care system, and nonspecialists often are called on to fill open specialist positions. The impact of clinical pharmacy specialists on pharmacotherapy outcomes in both acute care and primary care settings demonstrates the value of these specialists. This commentary articulates the need for postgraduate year two (PGY2)-trained clinical specialists within the health care system by discussing various clinical and policy rationales, interprofessional support, economic justifications, and their impact on quality of care and drug safety. The integrated practice model that has grown out of the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative (PPMI) could threaten the growth and development of future clinical specialists. Therefore, the ways in which PGY2-trained clinical pharmacist specialists are deployed in the PPMI require further consideration. PGY2 residencies provide education and training opportunities that cannot be achieved in traditional professional degree programs or postgraduate year one residencies. These specialists are needed to provide direct patient care to complex patient populations and to educate and train pharmacy students and postgraduate residents. Limitations to training and hiring PGY2-trained clinical pharmacy specialists include site capacity limitations and lack of funding. A gap analysis is needed to define the extent of the mismatch between the demand for specialists by health care systems and educational institutions versus the capacity to train clinical pharmacists at the specialty level.

Advancing the pharmacy practice model through statewide resident collaboration

In 2011, ASHP and the ASHP Research and Education Foundation published recommendations from the Pharmacy Practice Model Initiative (PPMI).[1][1] The recommendations set ambitious goals for national pharmacy practice advancement and individual pharmacy departments. For the past two years, the

Issues facing pharmacy leaders in 2014: suggestions for pharmacy strategic planning.

In 2013, the Director's Forum published our assessment of issues facing pharmacy leaders to assist pharmacy directors in planning for the year ahead. The issues include health care reform and the Affordable Care Act, the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative, the health care workforce, patients' perceptions of pharmacists, and the changing landscape of pharmacy education. Based on our environmental scan, the issues addressed in 2013 are pertinent to a department's plan for 2014. The goal of this article is to provide practical approaches to each of these issues to help pharmacy directors focus their department's goals for 2014 to support the development of patient-centered pharmacy services. This column will address (1) strategies to reduce medication costs and generate new pharmacy revenue streams, (2) innovative approaches to improving medication safety and quality, (3) steps to advance the clinical practice model, and (4) ways to create mutually beneficial student experiences.

How space design and technology can support the Pharmacy Practice Model Initiative through interprofessional collaboration

Purpose: The Pharmacy Practice Model Initiative (PPMI) calls pharmacists to more direct patient care and increased responsibility for medication-related outcomes, as a means of achieving greater safety, improving outcomes and reducing costs. This article acknowledges the value of interprofessional collaboration to the PPMI and identifies the implications of the Initiative for space design and technology, both of which stand to help the Initiative gather additional support.&#x0D; Summary: The profession of pharmacy has for some time now become increasingly vocal about its desire to take on greater responsibility for patient outcomes. With drug costs representing the largest portion of a hospital's pharmacy budget and reimbursements becoming more contingent on readmission avoidance, the pharmacy's influence on a hospital's bottom line is significant. More importantly, study after study is showing that with greater pharmacist intervention, patient outcomes improve. This article addresses the ways in which developments in the fields of technology and facility design can assist in the deployment of the PPMI.&#x0D; Conclusion: As the PPMI achieves a critical level of support from inside and outside the pharmacy, and more empirical research emerges regarding the improved outcomes and cost savings of increasing the roles of both clinical pharmacists and pharmacy technicians, the industry sectors of healthcare technology and healthcare design stand ready to assist in the execution of this new model. By encouraging pharmacists, doctors and nurses to work together - and all caregivers to work with facility designers, biomedical engineers and IT specialists, there is the increased likelihood of these fields turning to each other to problem-solve together, all for the ultimate benefit to patients and their families.&#x0D; &#x0D; Type: Commentary

Role of executive coaching in pharmacy management

A strong commitment to self-management is a key component in the overall effectiveness of a manager. Regardless of experience, position, or title, pharmacists in management positions must be vigilant in developing themselves both personally and professionally. In addition to the support they receive from their mentors, managers can gain important leadership skills by pursuing executive coaching. Executive coaching can take on a myriad of forms, from helping executives transition into a new role to providing them with individual support through the development of specific skills or behaviors. As the Pharmacy Practice Model Initiative remains at the forefront of pharmacy leadership, executive coaching can serve as yet another tool for pharmacists to further develop management and leadership skills. It is critical for health systems to focus on leadership acquisition and the retention of existing intellectual capital as well as embrace and provide for emerging pharmacy management practitioners. Part of this can be accomplished by proactively making available coaching resources to develop the behavioral and business competence of pharmacy leaders.1